Abstract
In systemic sclerosis patients, interstitial lung disease and pulmonary hypertension are highly associated with mortality. The time point of detecting manifestations like pulmonary hypertension and interstitial lung disease (ILD) is of vital importance. High-resolution computed tomography (HRCT) to date is the gold standard to diagnose ILD. In addition, an ultrasound of the lung is suggested as a noninvasive and radiation-free method of structural monitoring of the lung. We tested the reliability of lung sonography for the assessment of patients with systemic sclerosis. In a pilot study involving 25 patients with systemic sclerosis and 40 healthy volunteers, we screened the pleura and the pulmonary parenchyma for sonographic abnormalities. The occurrence of B lines, comet tail phenomena, and pleural irregularities was scored. All systemic sclerosis (SSc) patients were subjected to computed x-ray tomography of the chest. Forty-four percent of SSc patients showed B line phenomena and pleural thickening. The diagnosis of ILD in these patients was confirmed by HRCT scan. B line phenomena and pleural irregularities were significantly more common in SSc patients. Patients with ILD had higher pleural scores and comet scores when compared to systemic sclerosis patients without radiographic ILD. If our results are confirmed in larger studies, transthoracic ultrasound of the lung might turn out to be a suitable method for screening patients with systemic sclerosis for incipient pulmonary structural changes.
References
Katsumoto TR, Whitfield ML, Connolly MK (2011) The pathogenesis of systemic sclerosis. Annu Rev Pathol 6:509–537
Klein-Weigel P, Opitz C, Riemekasten G (2011) Systemic sclerosis—a systematic overview: part 1—disease characteristics and classification, pathophysiologic concepts, and recommendations for diagnosis and surveillance. VASA.Zeitschrift fur Gefasskrankheiten. J Vasc Dis 40(1):6–19
Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE et al (2010) Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis 69(10):1809–1815
Hosing C, Nash R, McSweeney P, Mineishi S, Seibold J, Griffith LM et al (2011) Acute kidney injury in patients with systemic sclerosis participating in hematopoietic cell transplantation trials in the United States. Biology of Blood and Marrow Transplantation: Journal of the American Society for Blood and Marrow Transplantation 17(5):674–681
Walker KM, Pope J et al (2011) Expert agreement on EULAR/EUSTAR recommendations for the management of systemic sclerosis. J Rheumatol 38:1326–1328
Khanna D, Denton CP (2010) Evidence-based management of rapidly progressing systemic sclerosis. Best practice & research. Clin Rheumatol 24(3):387–400
El-Hag K, Dercken HG, Prenzel R, Holzle E (2008) Drug-induced alveolitis associated with infliximab/azathioprine therapy. Pneumologie (Stuttgart, Germany) 62(4):204–208
Searles G, McKendry RJ (1987) Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol 14(6):1164–1171
Nishimura K, Kitaichi M, Izumi T, Itoh H (1992) Diffuse panbronchiolitis: correlation of high-resolution CT and pathologic findings. Radiology 184(3):779–785
Screaton NJ, Hiorns MP, Lee KS, Franquet T, Johkoh T, Fujimoto K et al (2005) Serial high resolution CT in non-specific interstitial pneumonia: prognostic value of the initial pattern. Clin Radiol 60(1):96–104
Remy-Jardin M, Remy J, Cortet B, Mauri F, Delcambre B (1994) Lung changes in rheumatoid arthritis: CT findings. Radiology 193(2):375–382
Diot E, Boissinot E, Asquier E, Guilmot JL, Lemarie E, Valat C et al (1998) Relationship between abnormalities on high-resolution CT and pulmonary function in systemic sclerosis. Chest 114(6):1623–1629
Wohlgenannt S, Gehmacher O, Gehmacher U, Kopf A, Mathis G (2001) Sonographic findings in interstitial lung diseases. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 22(1):27–31
Reissig A, Kroegel C (2003) Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. Journal of Ultrasound In Medicine: Official Journal Of the American Institute of Ultrasound in Medicine 22(2):173–180
Reissig A, Gorg C, Mathis G (2009) Transthoracic sonography in the diagnosis of pulmonary diseases: a systematic approach. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 30(5):438–454, quiz 455–6
Doveri M, Frassi F, Consensi A, Vesprini E, Gargani L, Tafuri M et al (2008) Ultrasound lung comets: new echographic sign of lung interstitial fibrosis in systemic sclerosis. Reumatismo 60(3):180–184
Avouac J, Fransen J, Walker UA, Riccieri V, Smith V, Muller C et al (2011) Preliminary criteria for the very early diagnosis of systemic sclerosis: results of a Delphi Consensus Study from EULAR Scleroderma Trials and Research Group. Ann Rheum Dis 70(3):476–481
Mathis G, Gehmacher O (2001) Lung and pleural ultrasound. Praxis 90(16):681–686
Sperandeo M, Varriale A, Sperandeo G, Filabozzi P, Piattelli ML, Carnevale V et al (2009) Transthoracic ultrasound in the evaluation of pulmonary fibrosis: our experience. Ultrasound Med Biol 35(5):723–729
Lichtenstein DA (2007) Ultrasound in the management of thoracic disease. Crit Care Med 35(5 Suppl):S250–S261
Lichtenstein D, Meziere G (1998) A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med 24(12):1331–1334
Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G et al (2011) Lung ultrasound in bronchiolitis: comparison with chest X-ray. Eur J Pediatr 170:1427–1433
LeRoy EC, Medsger TA Jr (2001) Criteria for the classification of early systemic sclerosis. J Rheumatol 28(7):1573–1576
Acknowledgments
This study was funded by “Land Steiermark,” Austria. Thanks to Mrs. Lamont Eugenia for her corrections.
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Moazedi-Fuerst, F.C., Zechner, P.M., Tripolt, N.J. et al. Pulmonary echography in systemic sclerosis. Clin Rheumatol 31, 1621–1625 (2012). https://doi.org/10.1007/s10067-012-2055-8
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DOI: https://doi.org/10.1007/s10067-012-2055-8